Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs: Cost-effectiveness analysis of a randomized controlled trial

Anne B. Wichmann, Eddy M.M. Adang, Kris C.P. Vissers, Katarzyna Szczerbińska, Marika Kylänen, Sheila Payne, Giovanni Gambassi, Bregje D. Onwuteaka-Philipsen, Tinne Smets, Lieve Van Den Block, Luc Deliens, Myrra J.F.J. Vernooij-Dassen, Yvonne Engels, Paula Andreasen, Ilona Barańska, Catherine Bassal, Danni Collingridge Moore, Harriet Finne-Soveri, Katherine Froggatt, Teija HammarRauha Heikkilä, Jo Hockley, Elisabeth Honinx, Hein Van Hout, Violetta Kijowska, Maud Ten Koppel, Outi Kuitunen-Kaija, Suvi Leppäaho, Federica Mammarella, Martina Mercuri, Rose Miranda, Emilie Morgan De Paula, Nele Van Den Noortgate, Mariska Oosterveld-Vlug, Agnieszka Pac, H. Roeline W. Pasman, Sophie Pautex, Sheila Payne, Ruth Piers, Lara Pivodic, Paola Rossi, Katarzyna Szczerbińska, Ivan Segat, Jenny T. Van Der Steen, Agata Stodolska, Marc Tanghe

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4 Citations (Scopus)


Background: The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the 'PACE Steps to Success' intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. Methods: A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. Results: Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). Conclusions: Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. Trial registration: ISRCTN14741671.

Original languageEnglish
Article number258
JournalBMC medicine
Issue number1
Publication statusPublished - 22 Sept 2020


  • Cost-benefit analysis
  • Nursing homes
  • Palliative care
  • Teaching

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